What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Saturday, February 18, 2006

Why Primary Care Reform

I suppose since the blog site has used the term “primaryhealthcare” it is time I said a few words about what the term “primary Health Care” actually means(this will vary depending who you ask).
Traditionally, this term meant the first “physician” contact a patient made in the community when they required “health care”. “Secondary care” would be those groups of health care providers that the physician deemed where necessary to address the “patient care” issues of that person. “Tertiary care” simply referred to “hospital” care and “long term” care referred to “nursing home” care. This worked very well for me over the years. Over my years of practice I developed a group of care providers that I had confidence in and worked well with. I made it a point to know their strengths and weaknesses, their standard of care and their dedication. In effect this was a team of practitioners (physiotherapists, pharmacists, chiropractors, homeopathic practitioners, surgeons, medical specialist, palliative care nurses, etc) that worked together as a team, a team that I had confidence in, and who had confidence in me. My office nurse was with me in practice for 37 years and knew my patients extremely well and decisions to refer were based on both physical and emotional needs (I even considered referrals based on personalities that would get along). This team of professionals served our community for 37 years, was stable and extremely cost effective. Rarely would a patient be referred for a hip replacement that did not need a hip replacement. Over the years my patients were educated as to when they needed to see me and when they did not, and when they were in doubt, my office nurse in whom they had great trust, gave them appropriate advice. Our practitioner group had a 24/7 call system and over the years we even got to know the other doctors patients. Very few of my patients had under treated high blood pressure or high cholesterol. Obviously, this is a system that needed to be “reformed”!
My patients knew that I was a great believer in preventative measures and basically I think that the patients that were non compliant just got tired of my “nagging” and found some other physician. I was a believer in education AND motivation.
One such patient advised me that she was changing doctors because she was tired of my nagging her about her weight every time she saw me. She had diabetes, high blood pressure, esophageal reflux, and severe arthritis of her back and weight bearing joints. She was also 50 lbs overweight. Eight months later I received a letter from her saying she liked me as her physician and wished to return to my practice (Something I rarely allowed). On this occasion I allowed an interview and invited her in for a chat. I pointed out that it was inappropriate for me to care about her health more than she did and reiterated that weight loss would help all of her ailments. I would take her back only if she lost the weight and I promised that I would not mention it again unless she went over the 10 pound leeway we agreed to. She joined Weight Watchers and lost 45 pounds and experienced considerable improvement in all her symptoms. She also kept the weight off over the next twenty years that I cared for her until my retirement.
Today the public is being sold a new definition of Primary Health Care. Details can be found at www.primaryhealthcare.ca. An incredible amount of money is being poured into various projects under the banner of “primary health care reform”, “primary health care initiatives”, “primary health organizations (PHO---New Zealand), etc. Their definition of primary care is: “basic, every day health care. Primary health care could be visiting the family doctor or nurse practitioner, talking to a dietician or pharmacist, or calling a toll free health advice line to talk to a health professional. It is usually your first encounter with a health care provider when you need care and advice”. What is not said are things like who will be included as “health professionals” and “health providers”, can a patient have free access to all members of the “team”, how is the “team” put together, and who bears the “bottom line” responsibility when things don’t go well. Funding models vary. Interestingly, in Canada “extra billing” has been outlawed. In New Zealand (with their health care reform), they have encouraged it. They don’t call it extra billing, though. Doctors there charge what they wish, and the government pays a portion for the patient as a fee subsidy.
Tomorrow, we will look at the new “vision” of patient care and primary health care reform, and speculate at the reasons for starting down this road. In the mean time a ‘PROMO” of the concept can be found at “www.primaryhealthcare.ca”.


Blogger greentogroove said...

I appreciate your stop my blog... enjoyed yours immensely, as I remember my hometown physician of youth. I had not yet thought through your perspective and appreciated the fresh view.

18/2/06 9:11 PM  
Blogger Procrastinatrix said...

We were told (in nutrition) primary health care is preventative health care, which I guess would be in line with what you say it is. Regular checkups etc would be considered preventative. We learned that tertiary was treating a problem that had already developed. A little bit of a different angle I guess, but same idea.

For the first time since I was a kid I have a "family" doctor, but unfortunately, its only temporary since I'm leaving in a few years....luckily I know a lot about my health!

20/2/06 12:45 PM  

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